CAT Instrument Development A national calibration study was completed this fiscal year. Responses to the items in each domain were obtained from large samples of SSA applicants and their health care providers (for a subset of these applicants). In addition, responses were collected from large normative samples of adults for the mobility and interpersonal interaction domains. Data analysis for the claimant and normative samples has been completed and will be presented to SSA on August 17, 2012, including a demonstration of the new CAT instruments. Varied aspects of these outcomes will be developed into manuscripts intended for publication. Analysis of provider data will be continued in FY2013 and initial validation studies will be conducted. Analysis of Existing SSA Data Analysis of existing SSA data is being conducted through a series of sub-projects. Three sub-projects were identified as priority research efforts during the past fiscal year. Adjudication Project The SSA adjudication process is a dynamic process, involving a complex sequence of decisions by several offices within SSA, which also includes the decisions and resources of the claimants themselves. NIH has undertaken the Adjudication 1 project to comprehensively model this process. We aim to develop systematic analytic methods to characterize program changes, quantify the extent to which SSA can adjust in response to these changes, predict how the system responds to exogenous demands, and derive useful statistics to monitor and adjust program performance. The Listings 1 Project The purpose of the Listing Coding Project is to assess the SSA Adult Listings with respect to the consistency and comprehensiveness with which functional criteria are presented, as a means to inform decisions about a claimants disability determination. Our objective is to examine the extent to which the Listings contain relevant functional criteria that can be applied in step three of SSAs sequential evaluation process, in which a claimants impairment must meet or equal the SSA Listings. We have proceeded to examine the inclusion of functional criteria in the SSA Listing Sections for Adults by applying the codes and procedures from the International Classification of Functioning, Disability and Health (ICF) to the SSA Listings, as reported in our first and third annual reports to SSA. As of July 31, 2012, the following four body systems have been coded by a second coder and compared with the codes from earlier rounds of coding: Musculoskeletal System (1.00); Cardiovascular System (4.00); Digestive System (5.00); and Mental Disorders (12.00). We present the results of the consensus coding process relative to codes assigned by the first coder to body systems 1.00, 4.00, 5.00 and 12.00. While consensus codes revealed an overall increase in the number of ICF Activity and Participation codes assigned to a given body system, the proportion of Activity and Participation codes by ICF component remains relatively consistent for each body system: The resulting set of consensus codes reflect agreement between the coders. The consensus codes are considered optimal based on the greater consistency between coders in applying coding rules. As a result of this detailed consensus coding process, we have developed over a dozen specific recommendations for revising the Adult Listings for SSAs consideration. For each recommendation, specific examples are included to further elucidate the recommendation. Although NIH has made more general recommendations for revising the Listings to SSA in past reports, we believe that the current set of recommendations is more actionable due to the level of specificity and associated examples that are provided. The CAL 2 Project The broad objective of the CAL2 project is to develop an empirical method that uses functional information to find new CAL conditions. This project is based on the assumption that if death is the cessation of all functional capabilities, and if the functional decline toward this cessation is a gradual or observable process, then it is conceptually possible to define a threshold beyond which work is unlikely. Based on this assumption, we aim to carry out the following objectives for CAL 2 project: Recommend a set of conditions for inclusion in the CAL program based on a claimants low functional status; Identify an empirical method to periodically update and validate the group(s) identified in objective 1. One step toward addressing these objectives involves identifying data sources that can be used to construct functional profiles associated with conditions and use them to determine the threshold of work disability of the reference group beyond which substantial gainful employment is highly unlikely. To address this need, the content of national surveys containing information on health conditions, work, and disability status were examined as potential data sources for this work. Survey questions relevant to disability were coded according to the World Health Organizations (WHO) International Classification of Functioning, Disability and Health (ICF). Disability related questions were selected from each of the following national surveys: National Health Interview Survey (NHIS) Current Population Survey (CPS) Survey of Impact and Program Participation (SIPP) National Survey of SSI Children and Families (NSCF) American Community Survey (ACS) In the past six months, two coders independently linked survey questions to components of the ICF and health. Approximately 917 questions and sub-questions were coded from all of the surveys. We are currently synthesizing the findings and will use these outcomes, along with changes in survey design over time and sampling frame, to inform selection of an optimal data source for analysis and development of a functional threshold for a reference group. The selection of a data source for subsequent empirical work is an important, labor-intensive step toward developing the functional profiles that will inform the CAL 2 work. Project Staffing Project staffing continues to grow to support the escalating analytical complexity and extensive scope of work. Two staff members and a post-doctoral fellow have joined the NIH team this past fiscal year. Project Accomplishments In addition to preparing multiple manuscripts for publication, this research has been presented to the SSA Commissioner and the Social Security Advisory Board. In addition, the work was presented as Congressional testimony to the House Ways and Means Committee, Social Security Subcommittee.